THE EFFECT OF LEGISLATIVE REQUIREMENTS ON THE USE OF BREAST-CONSERVING SURGERY

Background We studied the effect of state legislation requiring the di sclosure of options for the treatment of breast cancer on the use of b reast-conserving surgery in clinical practice. Methods The National Ca ncer Institute's Surveillance, Epidemiology, and End Results registry provided data on women from 30 through 79 years of age who underwent b reast-conserving surgery or mastectomy for local or regional breast ca ncer from 1983 through 1990. We examined the trend over time in the us e of breast-conserving surgery among patients in four sites (Connectic ut, Iowa, Seattle, and Utah) where there were no state laws specifical ly requiring the disclosure of options for the treatment of breast can cer by physicians. For four additional sites (Detroit, Atlanta, New Me xico, and Hawaii) that had such legislation, we determined whether the rate of breast-conserving surgery after the legislation was different from the expected rate. Results An attorney rated the legislation as giving most direction to physicians in Michigan, followed by Hawaii, G eorgia, and New Mexico. The rate of breast-conserving surgery was up t o 8.7 percent higher than expected in Detroit for six months after the passage of the Michigan law (P<0.01). The rate was up to 13.2 percent higher than expected in Hawaii for 12 months after that state's law w as passed (P<0.05) and up to 6.0 percent higher than expected in Atlan ta for 3 months after the passage of the Georgia law (P<0.01). After t hese transient increases, the surgery rates reverted to the expected l evels, No significant effect was detected in New Mexico, where only a resolution without legal force was passed. Conclusions Legislation req uiring physicians to disclose options for the treatment of breast canc er appeared to have only a slight and transient effect on the rate of use of breast-conserving surgery, (C) 1996, Massachusetts Medical Soci ety.